Let Incontinence Not Become Your Nightmare

Personal Management of Urinary Incontinence

There are many treatment methods for urinary incontinence. If the symptoms are affecting you, it would be best to consult your urologist. Discussing your urinary incontinence with your doctor may be uncomfortable, but it is very important for your health. There is no single method that treats everyone. The measures you take regarding your urinary incontinence can significantly improve your incontinence problem and lead to a better quality of life. These measures include lifestyle changes and bladder and pelvic floor muscle exercises. Methods such as surgery and medication treatments can be used when these methods are ineffective.

Lifestyle changes

Your daily diet may have an impact on your urinary incontinence. By paying attention to when, what, and how much you drink or eat, you can identify foods and beverages that affect your incontinence. Caffeine, alcohol, and soft drinks do not cause urinary incontinence, but they may increase the feeling of urgency and frequent urination in some people. Avoiding these types of beverages may improve your condition to some extent. Constipation and excessive weight gain are linked to urinary incontinence.

Bladder training

Your doctor may recommend bladder training for you. The first step in bladder training is keeping a bladder diary. This diary records how much fluid you drink, how frequently you urinate, and the amount of urine you pass.

Pelvic floor muscle exercises

The pelvic floor muscles support your bladder and bowels. These muscles can weaken with age, disease, or hormonal changes. Weak pelvic floor muscles may cause urinary incontinence. Pelvic floor muscle exercises and programs designed for these exercises can correct urinary incontinence. These programs are pelvic floor muscle exercises tailored to your specific needs.

Medication treatment for urinary incontinence

The treatment for urinary incontinence depends on the type of incontinence, how severe it is, and what is causing it. Self-management treatments for urinary incontinence (see Management of Urinary Incontinence) are often combined with medication. Together with your doctor, you can decide which medication treatment is most suitable for you. The primary medications used in the treatment of urinary incontinence are muscarinic receptor antagonists (MRAs), mirabegron, and estrogen. Other medications include desmopressin and duloxetine.

Surgical Methods

Placement of the Hanger

Placement of a sling is the standard surgical treatment method for women with stress urinary incontinence. Slings provide support to the pelvic floor muscles and help the urethra resist better pressure from a full bladder. Suspension devices are placed under the urethra to support it. Different types of suspension devices exist depending on the following characteristics:

• Their contents. The suspenders may be synthetic or contain human or animal tissue. Their shapes. The suspenders may be of varying lengths and thicknesses. Methods of tissue attachment: Which type of suspension will be recommended depends on your individual situation and needs. This also depends on which types of suspensions are available at your hospital and your surgeon's level of experience.

When should I consider a sling operation?

Suspension placement is the most recommended treatment option for SUI. In 85-90% of cases, suspensions improve SUI. If the surgery is successful, the effect is usually long-lasting. If you have mixed-type urinary incontinence, your doctor may also recommend this surgery. Since this surgical method aims to correct SUI symptoms, it may be less effective.

How is the catheter placed?

For the surgery, local or spinal anesthesia is typically used, although in some cases general anesthesia is recommended. First, your doctor inserts a catheter to ensure your bladder remains empty throughout the surgery. Then, your doctor makes an incision in front of the vaginal wall to place the sling. To create a hammock-style sling, each end of the sling is positioned on both sides of the urethra. Finally, the ends of the sling are attached to the tissue. In retropubic suspensions, the ends are attached just above the pubic bone. In the transobturator suspension method, the ends of the sling are attached to the tissue around the pubis.

Overactive Bladder (Intravesical Botox Injection - TENS Therapy)

The application of BoNT-A has become widespread in cases where the drug cannot be continued due to side effects, and the European Urology Manual (2012) recommends the application of Onabotulinum toxin A (100-300 U) in the Urinary Incontinence section as Evidence Level 1 for the treatment of compression-type urinary incontinence.

Stress Incontinence After Prostate Surgery

Prostate surgery increases the risk of stress urinary incontinence (SUI). This is because the prostate surrounds the urethra and helps provide resistance against the pressure of a full bladder. If your prostate has been partially or completely removed, this affects the pressure tolerance of your urinary sphincter. Here, treatment options for SUI occurring after prostate surgery are shown. The most commonly applied treatments are:

• Pelvic floor exercises Sling placement Artificial compression devices (balloon placement) Artificial urinary sphincter implantation (AÜS)

References:

• European Association of Urology. Urinary Incontinence Guidelines.

• International Continence Society. Terminology and Management of Urinary Incontinence.

• American Urological Association. Diagnosis and Treatment of Overactive Bladder.

• National Institute for Health and Care Excellence. Urinary Incontinence Clinical Guideline.